Citrobacter freundiicausing pharyngitis and secondary retropharyngeal abscess with intrathoracic extension to the diaphragm: minimally invasive management of a rare case

2010 ◽  
Vol 124 (5) ◽  
Author(s):  
A Trinidade ◽  
V Sekhawat ◽  
Z Andreou ◽  
J Meldrum ◽  
S Kamat ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Head And Neck ◽  
Clinical Course ◽  
Retropharyngeal Abscess ◽  
Morbidity Rate ◽  
Suction Catheter ◽  
High Morbidity ◽  
Pharyngeal Wall ◽  
Invasive Approach ◽  
High Morbidity Rate

AbstractIntroduction:Citrobacter freundiiis a rare but potentially aggressive cause of pharyngitis which may progress to retropharyngeal abscess with diaphragmatic extension.Objective:To raise awareness of: (1) citrobacter as a potential cause of head and neck infection, including retropharyngeal abscess; (2) a novel surgical approach to draining such an abscess; and (3) citrobacter's particular biological properties which may affect the clinical course.Method:Case report.Results:The abscess was drained via a minimally invasive posterior pharyngeal wall incision and placement of a suction catheter into the mediastinum through this incision. Residual intrathoracic collections were drained by the cardiothoracic team via percutaneous aspiration. The patient made a full recovery.Conclusion:Early recognition of citrobacter head and neck infections, an awareness of the peculiarities of the clinical course of such infections, and timely surgical intervention can prevent catastrophic outcomes. A minimally invasive approach to mediastinal collections can be considered as a viable alternative to open thoracotomy, which carries a high morbidity rate.

P54 INCIDENCE AND OUTCOME OF HIATAL HERNIA AFTER OESOPHAGECTOMY: COMPARISON OF TRADITIONAL OPEN AND MINIMALLY INVASIVE APPROACH

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
Sanberg Ljungdalh Jonas ◽  
Markus Stilling Nicolaj ◽  
Patrick Ainsworth Alan ◽  
Hareskov Larsen Michael
Keyword(s):  
Minimally Invasive ◽  
Hiatal Hernia ◽  
Malignant Disease ◽  
University Hospital ◽  
Morbidity Rate ◽  
High Morbidity ◽  
Electronic Patient Records ◽  
Invasive Approach ◽  
High Morbidity Rate

Abstract Aim The primary aim of this retrospective study is to evaluate the incidence of symptomatic and asymptomatic hiatal hernia (HH) in patients who have undergone intended curative open or minimally invasive oesophagectomy (MIO) for cancer of the oesophagus in a high-volume surgical centre. The secondary aim is to describe the treatment and outcome after HH treatment. Background & Methods MIO for the treatment of oesophageal cancer has emerged as an alternative to traditional open oesophagectomy without compromising disease free or overall survival1. HH of abdominal viscera other than the gastric conduit is an infrequent but potentially life-threatening complication following oesophagectomy. HH may present with grievous complications, such as severe respiratory failure, intestinal ischemia with perforation, bowel obstruction, and strangulation leading to emergency surgery2,3. Surgical repair of these HHs is associated with a high morbidity rate and in the emergent setting even a high mortality4. In meta-analysis, the pooled incidence of symptomatic HH after MIO was 4.5 %, compared to a pooled incidence of 1.0 % after open oesophagectomy5. However, studies on the subject, often do not describe whether patients are asymptomatic or simply have not been examined for the existence of HH. The actual HH incidence may therefore be underestimated and may be more sufficiently reported when including patient material with comprehensive follow-up. This retrospective cohort study includes all patients (n≈455) who have undergone curative intended resection for malignant disease in the oesophagus at The Department of Surgery, Odense University Hospital, from 1th January 2012 – 31th December 2018. Patient demography, perioperative data including surgical approach and follow-up, including occurrence and treatment of hiatal hernia, mortality and recurrence of malignant disease will be extracted from complete electronic patient records. Follow-up ranges from 6-84 months. Primary outcome is occurrence of hiatal hernia after oesophagectomy determined by CT-scan or during surgery. Results As of abstract deadline for ESDE 2019, we have only just received permission for the study from The Danish Patient Safety Authority and can unfortunately not present our results yet. However, we expect that results are ready for presentation at ESDE 2019 and hope for your understanding.

P117 THE IMPACT OF ELDERLY ON SURGICAL OUTCOMES AFTER IVOR-LEWIS ESOPHAGECTOMY: REVIEW OF A SINGLE INSTITUTION EXPERIENCE

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
A Cossu ◽  
P Parise ◽  
F Puccetti ◽  
M Palucci ◽  
R Cerchione ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Elderly Patients ◽  
Morbidity Rate ◽  
High Morbidity ◽  
Consecutive Series ◽  
Ivor Lewis ◽  
High Morbidity Rate ◽  
Group A ◽  
Group B ◽  
The Impact

Abstract Background Esophagectomy is a surgical procedure burdened by a high morbidity rate. The effect of minimally invasive (MI) approach on elderly patients is still not clear. Aim of this study was to analyze the impact of MI approach on post-operative course according to the patient age. Methods A consecutive series of 692 patients underwent to elective oncological esophagectomy between 1997 and 2017. All data were entered into a prospective database. Patients submitted to 3-flield or trans-hiatal esophagectomy were excluded and only Ivor-Lewis open, hybrid or totally minimally invasive esophagectomy were evaluated. Patients were stratified according to age in 3 groups: Group A (≤ 50 years) 53 patients, Group B (> 51 and < 70 years) 269 and Group C (were ≥71 years) 126. Clinical and pathological factors influencing surgical outcome were evaluated. Complications were classified according to Clavien-Dindo (CD). Results As expected outcomes worsened with patients age (CD ≥ 3b: 7.5% group A, 13% group B and 21% group C. p=0.001), mortality (0% group A, 3% group B and 5.5% group C. p=0.035) and length of stay (10 days group A, 11 days group B and 13 days group C. p=0.001). A statistically significant higher incidence of anastomostic leaks was observed among patients submitted to totally MI esophagectomy in group C vs A and B that were respectively 12,5%, 0% and 7%. Major respiratory complications were not statistically different among these 3 three sub-group. Conclusions Old age has a significant impact on outcomes after esophagectomy. In this subset of patients a MI approach could also increase postoperative morbidity. Elderly patients should be carefully selected before to be submitted to MI esophagectomy.

scholarly journals Surveillance of influenza A H1N1 2009 among school children during 2009 and 2010 in São Paulo, Brazil

2012 ◽  
Vol 45 (5) ◽  
pp. 563-566 ◽  
Author(s):  
Sandra Baltazar Guatura ◽  
Aripuana Sakurada Aranha Watanabe ◽  
Clarice Neves Camargo ◽  
Ana Maria Passos ◽  
Sheila Negrini Parmezan ◽  
...  
Keyword(s):  
School Children ◽  
Influenza A ◽  
Respiratory Infections ◽  
Vaccination Campaign ◽  
Sao Paulo ◽  
Morbidity Rate ◽  
High Morbidity ◽  
São Paulo ◽  
High Morbidity Rate ◽  
Influenza A H1n1

INTRODUCTION: Influenza A H1N1 2009 is associated with a high morbidity rate among children around the world, including Brazil. This survey was conducted on samples of symptomatic children (< 12 years) to investigate the influenza virus as the etiological agent of respiratory infections in a day care school in a health facility during the first and second pandemic wave of H1N1 (2009-2010) in São Paulo, Brazil. METHODS: Influenza infections were determined by real-time PCR in 34% (47/137) of children with a median age of 5 years (8 months - 12 years), from June to October 2009 and in 16% (14/85) of those with median age of 6 years (1-12 years), from March to November 2010. RESULTS: In general, most positive cases (64%) occurred in children aged 5-12 years, this age group was significantly the most affected (39.8%, p = 0.001, OR = 8.3, CI 95% 1.9-36.9). Wheezing was reported by 31% (19/61) and dyspnea by 23% (14/61) of the studied patients. An outbreak of influenza H1N1 with an attack rate of 35.7% among children (median age 6 years) was documented in April 2010, before the vaccination campaign against the pandemic virus was extended for children up to 5 years in Brazil. CONCLUSIONS: Therefore, the study reinforces the recommendation to immunize school children to reduce the incidence of the disease.

scholarly journals Unsafe abortion among secondary school girls in a local authority in South-South Nigeria

2020 ◽  
Vol 9 (9) ◽  
pp. 3547
Author(s):  
Matthias G. Abah ◽  
Emem E. Bassey ◽  
Emmanuel B. Edu ◽  
Okupa D. Ovie
Keyword(s):  
Secondary School ◽  
Sex Education ◽  
Unwanted Pregnancy ◽  
Morbidity Rate ◽  
High Morbidity ◽  
School Students ◽  
Cross Sectional ◽  
Level Of Education ◽  
Dilation And Curettage ◽  
High Morbidity Rate

Background: Voluntary abortion for social reasons is illegal in Nigeria; however, the practice remains mostly clandestine and unsafe with varying consequences and determinants yet to be studied in all settings.Methods: A descriptive cross-sectional study design was used to assess the prevalence, practice and determinants of termination of pregnancy amongst 119 female Secondary School students in South-South Nigeria.Results: The prevalence of abortion was 57.1%. Most of the students were above 18years (58.8%), Christian (95.8%) and of rural residence (66.4%). While 58.8% had experienced an unwanted pregnancy, 61.4% had used some form of contraceptive with condom being the commonest (39.5%). Most (89.1%) have heard of abortions while 67.6% and 16.2% have had abortions once and twice respectively with the top reasons for abortion being that they were still in school (33.8%), too young (25.9%) and to avoid shame or stigma associated with the pregnancy (11.7%). Dilation and curettage was the predominant method employed (40.2%) mainly by medical doctors (34.1% and pharmacists (35.6%) while 51 (75%) had post-abortal complaints such as pain (41.2%) and bleeding (21.6%). There was a significant association between having an abortion and place of residence (rural more than urban), (p=0.04), being pregnant more than once (p<0.001), mothers` level of education (p=0.03), fathers` level of education (p=0.02) and mothers occupation (p=0.04).Conclusions: The prevalence of abortion is high and complicated by high morbidity rate despite a higher contraceptive prevalence rate whose major determinants were the socio-demographic characteristics of the parents. There is a need for early sex education from parents as this can influence abortion perception and practice in later years.

scholarly journals Monoclonal Antibodies in Multiple Sclerosis: Present and Future

Biomedicines ◽  
2019 ◽  
Vol 7 (1) ◽  
pp. 20 ◽  
Author(s):  
Natalia Voge ◽  
Enrique Alvarez
Keyword(s):  
Multiple Sclerosis ◽  
Monoclonal Antibodies ◽  
Morbidity Rate ◽  
High Morbidity ◽  
Disease Modifying Therapies ◽  
High Morbidity Rate ◽  
New Treatments ◽  
Near Future ◽  
Risk Ratios

The global incidence of multiple sclerosis (MS) appears to be increasing. Although it may not be associated with a high mortality rate, this disease has a high morbidity rate which affects the quality of life of patients and reduces their ability to do their activities of daily living. Thankfully, the development of novel disease modifying therapies continues to increase. Monoclonal antibodies (MABs) have become a mainstay of MS treatment and they are likely to continue to be developed for the treatment of this disease. Specifically, MABs have proven to be some of the most efficacious treatments at reducing relapses and the inflammation in MS patients, including the first treatment for primary progressive MS and are being explored as reparative/remyelinating agents as well. These relatively new treatments will be reviewed here to help evaluate their efficacy, adverse events, immunogenicity, and benefit-risk ratios in the treatment of the diverse spectrum of MS. The focus will be on MABs that are currently approved or may be approved in the near future.

scholarly journals The Population Pharmacokinetics of Rifampicin in Japanese Pulmonary Tuberculosis Patients

Drug Research ◽  
2020 ◽  
Vol 70 (05) ◽  
pp. 199-205
Author(s):  
Takahiro Nishimura ◽  
Haruichi Kohno ◽  
Hideaki Nagai ◽  
Daisuke Maruoka ◽  
Yuichi Koike ◽  
...  
Keyword(s):  
Population Pharmacokinetics ◽  
Japanese Patients ◽  
Morbidity Rate ◽  
Pharmacokinetic Parameters ◽  
Population Pharmacokinetic ◽  
High Morbidity ◽  
Power Model ◽  
Time Data ◽  
Nonlinear Mixed Effects Model ◽  
High Morbidity Rate

AbstractIn Japan, tuberculosis has been recognized as one of the major infections requiring urgent measures because of its high morbidity rate even now especially in elderly people suffering from tuberculosis during the past epidemic and its reactivation. Hence, many Japanese clinicians have made efforts to suppress the onset of tuberculosis and treat it effectively. The objectives of this study are to (1) identify covariate(s) that may explain the variation of rifampicin, which is the key antitubercular agent, under the steady-state by evaluating its population pharmacokinetics and (2) to propose an appropriate dosing method of rifampicin to Japanese patients. For this purpose, serum concentration–time data were obtained from 138 patients receiving rifampicin (300–450 mg) and isoniazid (300–400 mg) every day over 14 days, and analyzed using nonlinear mixed effects model. Thereby, population pharmacokinetic parameters were estimated followed by elucidating relations between the parameters and statistical factors. The analysis adopted one-compartment model including Lag-time by assuming that the absorption process is 0+1st order. The analyses demonstrate that meal affected the bioavailability, primary absorption rate constant, and zero order absorption time in the constructed model. A body weight calculated from the power model was selected as the covariate by the Stepwise Covariate Model method and found to highly affect the clearance in the range from −31.6% to 47.4%. We conclude that the dose in Japanese tuberculous patients can be well estimated by the power model formula and should be taken into consideration when rifampicin is administered.

High morbidity rate after converted laparoscopic colorectal surgery

1995 ◽  
Vol 82 (10) ◽  
pp. 1406-1408 ◽  
Author(s):  
K. Slim ◽  
D. Pezet ◽  
Y. Riff ◽  
E. Clark ◽  
J. Chipponi
Keyword(s):  
Colorectal Surgery ◽  
Laparoscopic Colorectal Surgery ◽  
Morbidity Rate ◽  
High Morbidity ◽  
High Morbidity Rate

scholarly journals Minimally Invasive Approach for Resection of Parameningeal Rhabdomyosarcoma

2016 ◽  
Vol 38 (03) ◽  
pp. 210-214
Author(s):  
Aileen Wertz ◽  
Brittny Tillman ◽  
Jennifer Brinkmeier ◽  
Tiffany Glazer ◽  
Andrew Kroeker ◽  
...  
Keyword(s):  
Adjuvant Therapy ◽  
Minimally Invasive ◽  
Head And Neck ◽  
Multidisciplinary Treatment ◽  
Cranial Base ◽  
Additional Treatment ◽  
Complete Resection ◽  
Surgical Biopsy ◽  
Invasive Approach

Background About one-third of rhabdomyosarcomas arise in the head and neck, with parameningeal primaries accounting for half of these. Principles of management involve chemotherapy, radiation, or both, in addition to surgical biopsy, debulking, and complete or near-complete resection. In the head and neck, diagnostic biopsies have historically been performed without attempt at resection due to proximity to critical structures and cosmetic considerations. Methods Retrospective chart review of three cases of rhabdomyosarcoma at the cranial base managed through minimally invasive endoscopic surgical resection and adjuvant therapy. Results Three patients were identified as having undergone endoscopic surgical debulking or margin-negative resection of a rhabdomyosarcoma of the cranial base. Two of three patients had complete resection based on intraoperative margin control. All three patients underwent adjuvant therapy within 1 month of diagnosis. Follow-up time ranged from 5 months to 3 years with all patients disease-free at last follow-up. Conclusion Skull base surgeons should routinely be involved in multidisciplinary treatment planning for parameningeal rhabdomyosarcomas, as surgical options have evolved to allow for potential endoscopic resection with low morbidity and no or minimal delay in additional treatment options.

scholarly journals Analysis Of Heart Decrease In Hypertension Patients With Karotis Artery Massage

2017 ◽  
Vol 1 (2) ◽  
pp. 1-5
Author(s):  
Asnidar ◽  
Tenriwati
Keyword(s):  
Public Health ◽  
Heart Rate ◽  
Carotid Artery ◽  
Health Center ◽  
Sampling Technique ◽  
Morbidity Rate ◽  
High Heart Rate ◽  
High Morbidity ◽  
Public Health Center ◽  
High Morbidity Rate

Hypertension is a disease that causes a high morbidity rate. The purpose of this study was to analyze the decrease in heart rate of hypertensive patients before and after doing massage on the carotid artery at the Bontobangun Public Health Center. design with population and sample that is all hypertension patients in Public Health Center of Bonto Public Health Center as many as 30 people. The sampling technique used was accidentaly sampling. The results of this study were in the pre-test there were 17 people (56.7%) who were in the category of moderate heart rate, 13 people (43.3%) high heart rate, in the post-test there were 25 people (83.3%) who had moderate heart rate , and 5 people (16.7%) had high heart rates. The conclusion of this study is that there is a decrease in heart rate of hypertension patients after carotid artery massage in public polyclinic public clinics at Bonto Wake with a value of p = 0.008 <α = 0.05. suggestions from this study are so that the results of this study can add a reference regarding carotid artery massage to decrease heart rate in patients with hypertension in the general poly bontobangun puskesmas.

scholarly journals SPINK7 Expression Changes Accompanied by HER2, P53 and RB1 may be Potential Biomarkers to Predict Oral Squamous Cell Carcinoma at Molecular Level

2020 ◽  
Author(s):  
Gina Penachiotti ◽  
Fabio Valdez ◽  
Wilfredo A González-Arriagada ◽  
Hector F Montes ◽  
Judith Parra ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Oral Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Oral Lesion ◽  
Normal Mucosa ◽  
Morbidity Rate ◽  
High Morbidity ◽  
Less Invasive ◽  
High Morbidity Rate

Abstract Background. The oral squamous cell carcinoma (OSCC) affects more than 300,000 patients annually worldwide with a high morbidity rate (37.8%). Several tumor biomarkers have been suggested to anticipate outcome but results were poor. Changes of SPINK7 and associated proteins in precancerous oral lesions could lead to genomic instability and promote oncogenesis. Our aim was to evaluate SPINK7as apotential molecular biomarkerpredictive of OSCC stages, compared with well-known molecules altered in cancer: HER2,TP53, RB1, NFKB and CYP4B1. Methods.Oral biopsies from patientswith dysplasia (n=33), less invasive(n=28) andhighly invasiveOSCC (n=18) were collected. 20 cases with a clinical suspicion but normal mucosa confirmedwere included ascontrol. Gene expression of SPINK7, P53,RB, NFKBand CYP4B1 were quantified by qPCR.SPINK7 levels were correlated with a cohort of 330 patients from the TCGA. Also,SPINK7, HER2, TP53, and RB1, were evaluated by immunohistofluorescence. One-way Kruskal-Wallis test and Dunn's post-hocwith a p<0.05 significance were used to data analyze.Results.In OSCC, SPINK7wasdown regulated andP53, RB, NFKB and CYP4B1were up regulatedrespect tothe others groups (p<0.001). Also,SPINK7 expressionwasdiminished in patients of TCGA(p=2.10e-6). In less invasive OSCC,SPINK7 and HER2 proteinswere decreasedandTP53 and RB1 significantly increasedrespect todysplasia and highly invasivegroups (p<0.05).Conclusion. Our results suggest that SPINK7changes accompanied of HER2, P53 and RB1 can be used to classify the molecular stage of epithelial oral lesion inthe OSCC, allowing a more accuratediagnosis to molecular and histopathological level.

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